Selected abstracts related with spine.

  • Anterior versus posterior approach in the treatment of chronic thoracolumbar fractures.
Chen ZW, Ding ZQ, Zhai WL, Lian KJ, Kang LQ, Guo LX, Liu H, Lin B.
Orthopedics. 2012 Feb 17;35(2):e219-24.

The purpose of this study was to compare the results of anterior approach vs
posterior approach in the treatment of chronic thoracolumbar fractures. A total
of 36 patients with chronic thoracolumbar fractures were divided into 2 groups.
Group A was treated by an anterior approach and group B was treated by a
posterior approach. During the minimum 24-month follow-up period (range, 24-62
months), all patients were prospectively evaluated for clinical and radiologic
outcomes. Intraoperative blood loss, operative time, operative complications,
pulmonary function, Frankel scale, and American Spinal Injury Association (ASIA)
motor score were used for clinical evaluation, and Cobb angle was examined for
radiologic outcome.All patients in this study achieved solid fusion, with
significant neurologic improvement. Operative time, perioperative blood loss,
ASIA score on admission and at final follow-up, and complications of respiratory
tract infection and intercostal nerve pain were not significantly different
between the 2 groups (P>.05), but complications of hemopneumothorax, abdominal
distension, and constipation were fewer in group B (P<.05). Postoperative
pulmonary function (P<.05) and correction of posttraumatic kyphosis were better in group B (P<.05).
PMID: 22310410

  • Prevalence of vertebral fracture in oldest old nursing home residents.
Rodondi A, Chevalley T, Rizzoli R.
Osteoporos Int. 2012 Feb 1. [Epub ahead of print]

We evaluated vertebral fracture prevalence using DXA-based vertebral fracture
assessment and its influence on the Fracture Risk Assessment (FRAX)
tool-determined 10-year fracture probability in a cohort of oldest old nursing
home residents. More than one third of the subjects had prevalent vertebral
fracture and 50% osteoporosis. Probably in relation with the prevailing influence
of age and medical history of fracture, adding these information into FRAX did
not markedly modify fracture probability.
INTRODUCTION: Oldest old nursing home residents are at very high risk of fracture. The prevalence of vertebral fracture
in this specific population and its influence on fracture probability using the FRAX tool are not known.
METHODS: Using a mobile DXA osteodensitometer, we
studied the prevalence of vertebral fracture, as assessed by vertebral fracture
assessment program, of osteoporosis and of sarcopenia in 151 nursing home
residents. Ten-year fracture probability was calculated using appropriately
calibrated FRAX tool.
RESULTS: Vertebral fractures were detected in 36% of oldest
old nursing home residents (mean age, 85.9 ± 0.6 years). The prevalence of
osteoporosis and sarcopenia was 52% and 22%, respectively. Ten-year fracture
probability as assessed by FRAX tool was 27% and 15% for major fracture and hip
fracture, respectively. Adding BMD or VFA values did not significantly modify it.
CONCLUSION: In oldest old nursing home residents, osteoporosis and vertebral
fracture were frequently detected. Ten-year fracture probability appeared to be
mainly determined by age and clinical risk factors obtained by medical history,
rather than by BMD or vertebral fracture.
PMID: 22302103 

  • Surgical vs Nonoperative Treatment of Hadley Type IIA Odontoid Fractures.
Aldrian S, Erhart J, Schuster R, Wernhart S, Domaszewski F, Ostermann R, Widhalm H, Platzer P.
Neurosurgery. 2012 Mar;70(3):676-83.

BACKGROUND: : Type II odontoid fractures with additional chip fragments are rare
in clinical practice, accounting for < 10% of all odontoid fractures. Hadley et
al were the first to describe these fractures as an individual subtype (IIA).
OBJECTIVE: : To analyze the outcome of patients after surgical or nonoperative
treatment of Hadley type IIA odontoid fractures.
METHODS: : We analyzed the records of 46 patients at an average of 64 years of
age at the time of injury. Twenty-five patients underwent surgical stabilization
by anterior screw fixation and were entered into study group A; 21 patients were
treated nonoperatively by halo vest immobilization and included in study group B.
RESULTS: : Thirty-seven patients (84%) returned to their preinjury activity level
and were satisfied with their treatment. Using the Cervical Spine Outcomes
Questionnaire to quantify the clinical outcome, we had an overall outcome score
of 21.8. We did not find a significant difference in the overall clinical outcome
between study groups. Bony fusion was achieved in 35 patients (80%). We had a
nonunion rate of 13% after anterior screw fixation and a significantly higher
rate of 30% after halo vest immobilization. Failure of reduction or fixation
occurred in 12 patients (27%), with a significantly higher failure rate after
halo vest immobilization.
CONCLUSION: : Hadley type IIA odontoid fractures are inherently unstable and
impede proper realignment. These fractures have a significantly increased risk
for secondary loss of reduction and bony nonunion, particularly after
nonoperative management. Early surgery should be considered to avoid further complications.
PMID: 22343791

  • Added value of percutaneous vertebroplasty: effects on respiratory function.
Tanigawa N, Kariya S, Komemushi A, Nakatani M, Yagi R, Sawada S.
AJR Am J Roentgenol. 2012 Jan;198(1):W51-4.

OBJECTIVE: The objective of our study was to investigate the effects of
percutaneous vertebroplasty on respiratory function in patients with compression
fractures caused by osteoporosis.
SUBJECTS AND METHODS: Ninety-eight patients (87 women, 11 men; mean age, 74
years; age range, 60-90 years) with compression fractures of 75 thoracic
(Th7-Th12) and 89 lumbar (L1-L5) vertebrae were enrolled in this study.
Percentage vital capacity (VC%), percentage forced vital capacity (FVC%), and
percentage forced expiratory volume in 1 second (%FEV1) were measured using a
spirometer before, 1 day after, and 1 month after percutaneous vertebroplasty.
The Wilcoxon signed rank test was used to evaluate whether any significant
differences in VC%, FVC%, or %FEV1 values existed between before, 1 day after,
and 1 month after percutaneous vertebroplasty.
RESULTS: The VC% and FVC% values had improved significantly by 1 month after
percutaneous vertebroplasty compared with before percutaneous vertebroplasty
(p<0.01). No significant difference was noted between values before and 1 day
after percutaneous vertebroplasty. Likewise, no significant difference was
identified in %FEV1 before percutaneous vertebroplasty and either 1 day or 1
month after percutaneous vertebroplasty. The mean degree of improvement in VC%
values after percutaneous vertebroplasty for patients with one vertebra treated,
which we refer to as the "single-vertebroplasty" group, and for patients with two
or more vertebrae treated, or "multiple-vertebroplasty" group, was 1.1%±7% (SD)
and 6.3%±8%, respectively, representing a significant difference between groups
(p=0.01). The mean VC% values before and 1 month after percutaneous
vertebroplasty differed significantly (p=0.02) in the thoracic group and overlapping group.
CONCLUSION: Percutaneous vertebroplasty improves restrictive ventilatory
impairment, but this improvement requires approximately 1 month to occur. Greater
improvement in restrictive ventilatory dysfunction was observed in patients who
underwent multiple vertebroplasty procedures than those who underwent a single
procedure and in patients who underwent treatment of thoracic vertebrae than
those who underwent treatment of other vertebrae.
PMID: 22194515 

  • The Incidence of Adjacent Segment Disease Requiring Surgery After Anterior Cervical Diskectomy and Fusion: Estimation Using an 11-Year Comprehensive Nationwide Database in Taiwan.
Wu JC, Liu L, Wen-Cheng H, Chen YC, Ko CC, Wu CL, Chen TJ, Cheng H, Su TP.
 Neurosurgery. 2012 Mar;70(3):594-601.

BACKGROUND:: The incidence of symptomatic adjacent segment disease (ASD) after
anterior cervical diskectomy and fusion (ACDF) was reported as 2.9%/y in a
previous cohort of 374 patients. Few other data corroborate the incidence and natural history of ASD.
OBJECTIVE:: To calculate the incidence of ASD after ACDF
that required secondary fusion surgery. METHODS:: The retrospective study used an
11-year nationwide database to analyze the incidences. All patients who underwent
ACDF for cervical disk diseases were identified through diagnostic and procedure
codes. Kaplan-Meier and Cox regression analyses were performed.
RESULTS:: From 1997 to 2007, covering 241 800 725.8 person-years, 19 385 patients received ACDF
and 568 had ≥ 2 ACDF operations. The incidence of secondary ACDF operations was
7.6 per 1000 person-years. At the end of the 10-year cohort, 94.4% of patients
who had received 1 ACDF remained free from secondary ACDF. The average time
interval between the first and second ACDF was 23.3 months. After adjustment for
comorbidities and socioeconomic status, secondary ACDF operations were more
likely performed on male patients (hazard ratio = 1.27; P = .008) 15 to 39 years
of age (hazard ratio = 1.45; P = .009) and 40 to 59 years of age (hazard ratio =1.41, P =.002, respectively).
CONCLUSION:: Repeat ACDF surgery for ASD cumulated
steadily in an annual incidence of approximately 0.8%, much lower than the
reported incidence of symptomatic ASD. However, at the end of this 10-year
cohort, a considerable portion of patients (5.6%) received a second operation.
Younger and male patients are more likely to receive such second operations.
PMID: 22343790 

  • Variations in sacral morphology and implications for iliosacral screw fixation.
Miller AN, Routt ML Jr.
J Am Acad Orthop Surg. 2012 Jan;20(1):8-16.

Posterior pelvic percutaneous fixation following either closed or open reduction
is a popular procedure. Knowledge of the posterior pelvic anatomy, its
variations, and related imaging is critical to performing reproducibly safe
surgery. The dysmorphic sacrum has several key characteristics. The upper portion
of the sacrum is relatively colinear with the iliac crests on the outlet
radiographic view. Other characteristics include the presence of mammillary
bodies (ie, underdeveloped transverse processes) at the sacral mid-alar area,
anterior upper sacral foramina that are not circular, residual upper sacral
disks, an acute alar slope oriented from cranial-posterior-central to
caudal-anterior-lateral on the outlet and lateral views of the sacrum, a
tongue-in-groove sacroiliac joint surface visualized on CT, and cortical
indentation of the anterior ala on the inlet radiographic view. The surgeon must
be knowledgeable about individual patient anatomy to ensure safe iliosacral screw placement.
PMID: 22207514

  • Percutaneous vertebral body cement augmentation for back pain related to occultosteomyelitis/diskitis.
Buttermann GR, Mullin WJ.
Orthopedics. 2011 Nov 9;34(11):e788-92. doi: 10.3928/01477447-20110922-31.

Although complications related to vertebroplasty or kyphoplasty are few, we
treated 2 patients with vertebroplasty or kyphoplasty for pain, presumed to be
due to vertebral compression fractures, which were subsequently found to be due
to occult osteomyelitis/diskitis. The onset of their infections appeared to have
preceded their vertebral body augmentation procedures and was possibly due to
prior interventional procedures for histories of back pain.An 86-year-old woman
had had 3 prior kyphoplasty procedures for fractures at T10, T11, and L1. She
reported continued severe pain, and subsequent magnetic resonance imaging was
misinterpreted for another fracture at T12, resulting in her fourth kyphoplasty.
She became septic and had some improvement with antibiotics, but she declined
specialty care and died. A 74-year-old man with chronic back pain had recently
undergone lumbar facet joint injections. Computed tomography and subsequent bone
scan found uptake at both L2 and L3. Despite abnormal erythrocyte sedimentation
rate and C-reactive protein level and normal radiographic vertebral height, he
underwent a vertebroplasty. His pain increased, and subsequent workup found L2-3
diskitis. He recovered with antibiotics and specialty care. Similar to prior
reports of spondylodiskitis, both patients had multiple medical
comorbidities.This article emphasizes the need for clinical reevaluation and
scrutiny in the interpretation of imaging studies, including for infection in
patients with continued pain after spinal procedures. The differential diagnosis
of infectious etiology is an important consideration prior to vertebral cement augmentation for presumed fragility fracture.
PMID: 22049968

  • The Utility of Bone Cement to Prevent Lead Migration with Minimally Invasive Placement of Spinal Cord Stimulator Laminectomy Leads.
Connor DE Jr, Cangiano-Heath A, Brown B, Vidrine R, Battley T 3rd, Nanda A, Guthikonda B.
Neurosurgery. 2012 Feb 6.

Lead migration is a significant concern with spinal cord stimulator (SCS) placement with rates ranging from 10-60%.
We describe a novel technique utilizing bone cement at the laminotomy site to help prevent lead migration after minimally invasive placement of laminectomy paddle leads, and present our short term results. METHODS: A review of a prospectively maintained database identified all patients who underwent minimally invasive placement of laminectomy leads with use of bone cement. All procedures were performed between  July 2008 and August 2010 utilizing conscious sedation and local anesthetic. Intraoperative testing was performed to confirm good pain coverage. A small volume of bone cement (1-3 cc) was then placed to cover the laminectomy defect. Radiographic and clinical follow up was assessed.
Forty-two patients (mean age 58.0 yrs) underwent 42 procedures. Back pain (88.1%) and leg pain (88.6%) were the most common presenting symptoms. No intraoperative complications were noted. Two (4.8%) patients required removal of their devices due to non-healing wounds. All patients were followed for a minimum of six months and no cases of clinical or radiographic lead migration have been seen at the time of
CONCLUSION: We present a novel technique in hopes of decreasing the incidence of lead migration after minimally invasive placement of spinal cord stimulator laminectomy paddle leads. Our results have been promising thus far with no cases of lead migration.

  • Percutaneous vertebroplasty for pathological vertebral compression fractures secondary to multiple myeloma.
Chen LH, Hsieh MK, Niu CC, Fu TS, Lai PL, Chen WJ.
Arch Orthop Trauma Surg. 2012 Feb 8. [Epub ahead of print]

BACKGROUND: Vertebral compression fractures are common in multiple myeloma. Percutaneous vertebroplasty is used to stabilize vertebral collapse and treat the pain. The major technical drawbacks of percutaneous vertebroplasty are the potential for neural comprise and pulmonary embolism of cement from leakage of polymethylmethacrylate into epidural space and perivertebral veins. We have retrospectively evaluated the safety and complication of percutaneous vertebroplasty in the vertebral compression fractures resulting from multiple myeloma.

METHODS: From August 2003 to July 2008, we describe 24 patients withmultiple myeloma who were treated for vertebral compression fractures with percutaneous vertebroplasty to a total of 36 vertebrae. There were 4 male and 20 female patients with an average age of 67 (range 54-81 years). The pain symptoms were measured on a visual analog pain scale and quality of life as measured by the physical component summary scale of the Short Form-36 before operation and at 24 h, at 3 months and at 1 year following vertebroplasty. Radiography was
reviewed for evidence of cement leakage and pulmonary complication.
RESULTS: The mean visual analog pain scale decreased from a preoperative value of 9.0-3.8 at 24 h following operation and SF-36 score improved from 22.1 to 41.8. Of the twenty-four patients, four had cement leakage (2 leak through inferior endplate into disc, 2 leak into perivertebral vessels). There were no intra-postoperative neurologic or pulmonary complications. Eight patients died 2-18 months
post-operatively due to multiple myeloma-related organ failure.
CONCLUSIONS: In this study, vertebroplasty significantly improved pain scores and function and, thereby, the quality of life. There were no major procedure-related complications in this study. Direct cytotoxic effect, polymerization and biomechanical microfractures stabilizer of polymethylmethacrylate play multiple roles in pain relief. In multiple myeloma, when pathological spinal compression fractures cause intractable pain and are unresponsive to conservative treatment, vertebroplasty remains the best option for pain relief and is effective in increasing quality of life.
PMID: 22314399
  • Comparison of stability of two kinds of sacro-iliac screws in the fixation of bilateral sacral fractures in a finite element model.
Injury. 2012 Jan 24. [Epub ahead of print]
Zhao Y, Li J, Wang D, Liu Y, Tan J, Zhang S.
Department of Orthopaedics, Yantai Shan Hospital, Yantai, Shandong, PR China.

To compare the stability of lengthened sacro-iliac screw and sacro-iliac screw for the treatment of bilateral vertical sacral fractures to provide reference for clinical application.
A finite element model of Tile C pelvic ring injury (bilateral type Denis II fracture of sacrum) was produced. (Tile and Denis are surgeons, who put forward the classifications of pelvic ring injury and sacral fracture respectively.) The bilateral sacral fractures were fixed with a lengthened sacro-iliac screw and a sacro-iliac screw in seven types of models, respectively. The translation and angular displacement of the superior surface of the sacrum in the case of standing on both feet were measured and compared.
The stability of one lengthened sacro-iliac screw fixation in the S1 or S2 segment is superior to that of two bidirectional sacro-iliac screws in the same sacral segment; the stability of one lengthened sacro-iliac screw fixation in S1 and S2 segments, respectively, is superior to that of two bidirectional sacro-iliac screw fixation in S1 and S2 segments, respectively; the stability of one lengthened sacro-iliac screw fixation in S1 and S2 segments, respectively, is superior to that of one lengthened sacro-iliac screw fixation in the S1 or S2 segment; the stability of two bidirectional sacro-iliac screw fixation in S1 and S2 segments, respectively, is markedly superior to that of two bidirectional sacro-iliac screw fixation in the S1 or S2 segment and is also markedly superior to that of one sacro-iliac screw fixation in the S1 segment and one sacro-iliac screw fixation in the S2 segment; the vertical stability of the lengthened sacro-iliac screw or the sacro-iliac screw fixation in S2 is superior to that of S1. The rotational stability of the lengthened sacro-iliac screw or sacro-iliac screw fixation in S1 is superior to that of S2.
S1 and S2 lengthened sacro-iliac screws should be used for the fixation in bilateral sacral fractures of Tile C pelvic ring injury as far as possible and the most stable fixation is the combination of the lengthened sacro-iliac screws of S1 and S2 segments. Even if lengthened sacro-iliac screws cannot be used due to limited conditions, two bidirectional sacro-iliac screw fixation in S1 and S2 segments, respectively, is recommended. No matter which kind of sacro-iliac screw is applied, the fixation combination of S1 and S2 segments is strongly recommended to maximise the stability of the pelvic posterior ring.

  • The systemic inflammatory response after spinal cord injury in the rat is decreased by alpha4 beta1 integrin blockade.
J Neurotrauma. 2011 Dec 9. [Epub ahead of print]
Bao F, Omana V, Brown A, Weaver L.
Ontario, Canada

The systemic inflammatory response syndrome (SIRS) follows spinal cord injury (SCI) and causes damage to the lungs, kidney and liver due to an influx of inflammatory cells from the circulation. After SCI in rats, the SIRS develops within 12 h and is sustained for at least 3 days. We have previously shown that blockade of the CD11d/CD18 integrin reduces inflammation-driven secondary damage to the spinal cord. This treatment reduces the SIRS after SCI (Bao, et al, Exp.Neurol., 2011b). In another study we found that blockade of the a4ß1 integrin limited secondary cord damage more effectively than blockade of CD11d/CD18. Therefore, we considered it important to assess effects of an anti-?4ß1 treatment on the SIRS in the lung, kidney and liver after SCI. An anti-?4 antibody was given iv at 2 h after SCI at the 4th thoracic segment and effects on the organs were evaluated at 24 h after injury. The migration of neutrophils into the lungs  and liver was markedly reduced and all three organs contained fewer macrophages.  In the lungs and liver, activation of oxidative enzymes MPO, iNOS, COX-2 and gp91phox, production of free radicals, lipid peroxidation, and cell death, were substantially and similarly reduced. Treatment effects were less robust in the kidney. Overall, the efficacy of the anti-a4ß1 treatment did not differ greatly from that of the anti-CD11d antibody, although details of the results differed. The SIRS after SCI is a challenge to recovery and attenuation of the SIRS with an anti-integrin treatment is an important, clinically relevant finding.

  • The surgical treatment of Andersson lesions associated with ankylosing spondylitis.
Orthopedics. 2011 Jul 7;34(7):e302-6.
Wang G, Sun J, Jiang Z, Cui X.
Jinan City, Shandong Province, China

Eight men with Andersson lesions associated with ankylosing spondylitis who underwent surgical treatment were reviewed for this study. Eight Andersson lesions were found in the 8 patients, and all presented as pseudoarthrosis. Including a patient with obvious vertebral body destruction, no obvious local kyphosis was observed. Spinal cord compression and neural deficit were observed in 1 patient. Without established instructions for the surgical treatment of Andersson lesions, we alternated the surgical technique for each patient. Therefore, 5 patients, including the patient with obvious anterior destruction requiring reconstruction, underwent surgical treatment with lesion curettage and anterior bone graft and fusion; 3 other patients underwent surgical treatment without lesion curettage and anterior bone graft. All surgeries were performed from a posterior approach. Posterolateral autograft was supplemented to posterior instrumentation with or without anterior bone graft.All 8 patients experienced pain relief immediately postoperatively. No evidence of non-union was observed on radiographs at the level of pseudoarthrosis at final follow-up, and no neural and infectious complications were observed. Based on these results, surgical treatment with only posterior instrumentation supplemented by posterolateral autograft was effective for patients with Andersson lesions without obvious vertebral body destruction requiring reconstruction. Anterior lesion curettage and bone graft were not necessary. Solid immobilization, achieved by posterior instrumentation, should be the focus of the treatment of Andersson lesions with ankylosing spondylitis.

  • Osteoporos Int. 2012 Jan 21. [Epub ahead of print]
What is the importance of "halo" phenomenon around bone cement following vertebral augmentation for osteoporotic compression fracture?
Kim KH, Kuh SU, Park JY, Kim KS, Chin DK, Cho YE.
Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

We investigated the importance, risk factors, and clinical course of the radiolucent "halo" phenomenon around bone cement following vertebral augmentation for osteoporotic compression fracture. Preoperative osteonecrosis and a lump cement pattern were the most important risk factors for the peri-cement halo phenomenon, and it was associated with vertebral recollapse.
We observed a newly developed radiolucent area around the bone cement following vertebral augmentation for osteoporotic compression fractures. Here, we describe the importance of the peri-cement halo phenomenon, as well as any associated risk factors and long-term sequelae.
In total, 175 patients (202 treated vertebrae) were enrolled in this study. The treated vertebrae were subdivided into two groups: Group A (with halo, n?=?32) and Group B (without halo, n?=?170), and the groups were compared with respect to multiple preoperative (age, sex, BMD, preoperative osteonecrosis) and perioperative factors (operative approach: vertebroplasty or kyphoplasty; cement distribution pattern; cement leakage; cement volume), and postoperative results (VAS score, recollapse). Logistic regression analysis was used to evaluate the relationship between the incidence of the peri-cement halo and all of the parameters described above.
Rates of osteonecrosis were also significantly higher in Group A than in Group B (62.5% vs. 31.2%, p?<?0.05), and kyphoplasty (KP) was performed more frequently in Group A (43.8% vs. 17.6%, p?<?0.05). Lump cement (93.8% vs. 30.6%, p?<?0.05) and recollapse (78.1% vs. 24.7%, p?<?0.05) were also more common among individuals in Group A. Logistic regression analysis also showed that preoperative osteonecrosis (OR?=?3.679; 95% CI?=?1.677-8.073; p?=?0.001), KP (OR?=?3.630; 95% CI?=?1.628-8.095; p?=?0.002), lump pattern (OR?=?13.870; 95% CI?=?2.907-66.188; p?=?0.001), and vertebral recollapse (OR?=?5.356; 95% CI?=?1.897-15.122; p?=?0.002) were significantly associated with peri-cement halo.
The peri-cement halo was found to be associated with vertebral recollapse, this sign likely represents a poor prognostic factor after vertebral augmentation for osteoporotic compression fractures.

  • Two-level motor nerve transfer for the treatment of long thoracic nerve palsy.
J Neurosurg. 2011 Oct;115(4)858-64. Epub 2011 Jun 24.
Ray WZ, Pet MA, Nicoson MC, Yee A, Kahn LC, Mackinnon SE.
St.Louis, Missouri

The authors report a case of long thoracic nerve (LTN) palsy treated with two-level motor nerve transfers of a pectoral fascicle of the middle trunk, and a branch of the thoracodorsal nerve. This procedure resulted in near-total improvement of the winged scapula deformity, and a return of excellent shoulder function. A detailed account of the postoperative physical therapy regimen is included, as this critical component of the favorable result cannot be overlooked. This case establishes the two-level motor nerve transfer as a new option for treating LTN palsy, and demonstrates that nerve transfers should be considered in the therapeutic algorithm of an idiopathic mononeuritis.

  • Modified C-7 neurotization in the treatment of brachial plexus avulsion injury.
J Neurosurg. 2011 Oct;115(4):865-9. Epub 2011 Jul 15.
Lin H, Lv D, Hou C, Chen D.
Shanghai, People’s Republic of China.

Contralateral C-7 transfer is often used in patients with brachial plexus avulsion injury. Traditionally, the contralateral C-7 root has only been transferred to a single nerve, such as the median or radial nerve. In this study,
the authors aimed to evaluate the efficacy of contralateral C-7 transfer to 2 different recipient nerves in patients with brachial plexus avulsion injuries.
Between 2004 and 2008, 10 patients with brachial plexus root avulsions underwent nerve reconstruction using a modified C-7 neurotization technique. In this procedure, the contralateral C-7 root was transferred via vascularized ulnar
nerve grafts to both the musculocutaneous nerve and the median nerve on the affected side.
The strength of the biceps muscles increased to M3 or M4 in 6 patients and to M2 in 2 patients. The median nerve transfers led to regained motor function and strength of the wrist and finger flexors with improvement to M3 in 5
patients. Seven patients showed notable gains of sensory function (? S3).
Contralateral C-7 transfer to 2 different recipient nerves is a feasible and efficient approach in patients with brachial plexus avulsion injuries when the donor nerve is limited.

  • Modification of percutaneous vertebroplasty for painful old osteoporotic vertebral compression fracture in the elderly: Preliminary report.
Injury. 2012 Jan 9. [Epub ahead of print]
Shengzhong M, Dongjin W, Shiqing W, Yang S, Peng R, Wanli M, Chunzheng G.
Jinan Shandong, China

To study the clinical efficacy of modified percutaneous vertebroplasty (PVP) in the treatment of painful old osteoporosis vertebral compression fractures (OVCF).
From April 2007 to October 2009, 16 cases (23 vertebrae) of symptomic old OVCF were treated with a modified PVP. Before operation, all the patients were examined by standing anteroposterior and lateral X-Ray and MRI. The pain level of each patient was assessed before operation and 1 week, 6, 12 months after the operation using visual analogue scale (VAS) and Oswestry disability index (ODI). The middle line vertebral body height and local sagittal Cobb's angle were also measured.
Postoperative average VAS, Oswestry disability index (ODI), the local sagittal Cobb's angle decreased from 7.8, 72.3%, and 38.2° to 3.1, 26.8%, and 21.5° respectively before and after surgery (p<0.05). The mean midline vertebral height increased from 13.8mm to 26.6mm before and after surgery (p<0.05). There was no infection, nerve injury, pulmonary embolism, or death after operation.
The modified PVP can increase the space for bone cement filling and is good for the restoration of vertebral body height. It is an optimal procedure for the treatment of painful old OVCF.

  • Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.
Neurosurgery. 2012 Feb;70(2):306-11.
Lebow R, Parker SL, Adogwa O, Reig A, Cheng J, Bydon A, McGirt MJ.
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland.

Emotional distress and depression are common psychological disturbances associated with low-back and leg pain. The effects of lumbar discectomy on pain, disability, and physical quality of life are well described. The effects of discectomy on emotional distress and mental well-being are less well understood.
To assess the effect of microdiscectomy on depression, somatization, and mental well-being in patients with herniated lumbar discs.
Patients undergoing surgical discectomy for single-level, herniated lumbar disc were prospectively evaluated preoperatively, and at 6 weeks and 3, 6, and 12 months postoperatively. Back and leg pain, depression, somatic perception, and mental well-being were assessed.
One hundred patients were enrolled. All were available for 1-year follow-up. Preoperatively, the visual analog scale for low-back pain (BP-VAS), visual analog scale for leg pain (LP-VAS), Zung Self-Rating Depression Scale (ZUNG), Modified Somatic Perception Questionnaire (MSPQ), and Medical Outcomes Short Form-36 mental component summary scale (SF-36-MCS) were 6.3 ± 2.5, 6.3 ± 2.5, 19 ± 11, 9 ± 7, and 4 ± 14. BP-VAS and LP-VAS significantly improved by 6 weeks. Significant improvement in SF-36-MCS was observed by 6 weeks postoperatively, improvement in MSPQ score was observed 3 months postoperatively, and improvement in the ZUNG depression score was observed 12 months postoperatively. No statistical difference occurred during the remainder of follow-up for any outcome measured once improvement reached statistical significance. Eighteen patients were somatized preoperatively, 67% of which were nonsomatized 1 year postoperatively. Ten patients were clinically depressed preoperatively, 70% of which were nondepressed 1 year postoperatively. Improvement in SF-36-MCS, ZUNG, and MSPQ correlated (P < .001) with improvement in BP-VAS and LP-VAS.
The majority of patients somatized or depressed preoperatively returned to good mental well-being postoperatively. Improvement in pain and overall mental well-being was seen immediately after discectomy. Improvement in somatic anxiety and depression occurred months later. Microdiscectomy significantly improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc.

  • Long-Term Results of Spinal Cord Injury Therapy using Mesenchymal Stem Cells Derived from Bone Marrow in Humans.
Neurosurgery. 2011 Nov 29. [Epub ahead of print]
Park JH, Kim DY, Sung IY, Choi GH, Jeon MH, Kim KK, Jeon SR.

Although the transplantation of mesenchymal stem cells (MSCs) after spinal cord injury (SCI) has shown promising results in animals, less is known about the effects of autologous MSCs in human SCI.
To describe the long-term results of ten patients who underwent intramedullary direct MSCs transplantation into injured spinal cords.
Autologous MSCs were harvested from the iliac bone of each patient and expanded by culturing for 4 weeks. MSCs (8 × 10) were directly injected into the spinal cord, and 4 × 10 cells were injected into the intradural space of 10 patients with ASIA A or B caused by traumatic cervical SCI. After 4 and 8 weeks, an additional 5 × 10 MSCs were injected into each patient through lumbar tapping. Outcome assessments included changes in motor power grade of the extremities, magnetic resonance imaging (MRI), and electrophysiological recordings.
Although six of the ten patients showed motor power improvement of the upper extremities in six months follow-up, three showed gradual improvements in activities of daily living (ADL), and changes of MRI such as decreases of cavity size and the appearance of fiber-like low signal-intensity streaks. They also showed electrophysiological improvement. All ten patients did not experience any permanent complication associated with MSCs transplantation.
Three of the 10 patients with SCI who were directly injected with autologous MSCs showed improvement in motor power of upper extremities and in ADL, as well as significant MRI and electrophysiological changes during long-term follow-up.

  • Air in the Spinal Disc With Dissecting into Psoas Muscle After Trauma
J Trauma. 2011 Jun;70(6):1577.
Huang, Po-Wei MD; Cha, Tai-Lung MD, DPhil; Chang, Huang Ching MD; Wu, Sheng-Tang MD
Taipei, Taiwan, Republic of China.

An 86-year-old woman was brought to our emergency department with persistent pain in the upper region of the abdomen after a fall in which she hit her left buttock and flank 3 months previously. Local tenderness of the left flank was the only meaningful physical sign, and her vital signs were stable without fever. Laboratory examinations revealed a normal white blood cell count of 9,200/µL, with 81.3% neutrophils and a C-reactive protein level 1.66 mg/dL. Contrast-enhanced computed tomography of the abdomen revealed several bubbles of gas in the disc at L4–L5 and L3–L4 with dissection into the left psoas muscle (Fig. 1). Neither diverticulitis nor perforation of the gastrointestinal tract was identified. However, continuous bowel loop dilatation over the pelvis was identified on computed tomography findings. After observation and conservative treatment, the patient's symptoms improved, and there was no progression of peritoneal signs. The patient was ultimately discharged with some laxative drugs and was unremarkable at the regular follow-up.
The finding of free air in the peritoneal or retroperitoneal region of the abdomen often indicates life-threatening conditions, such as perforation of the gastrointestinal tract. In the absence of perforation of the gastrointestinal tract, several other conditions may be associated with free air, such as bronchial asthma, mechanical ventilation, or blast injury. In previous reports, the relationship between air bubbles in the spinal disc and pneumoretroperitoneum after trauma was not described. We describe a case of compression fracture of the lumbar spine with air entering the psoas muscle after blunt trauma. It was not difficult to hypothesize that the air was able to dissect from the adjacent anatomy and pass through a tear of ligament or fascia. Furthermore, on the basis of that proposed mechanism, we successfully avoided an invasive procedure in the presence of noticeable pneumoretroperitoneum.

  • New laboratory tools in the assessment of bone quality.
Osteoporos Int. 2011 Aug;22(8):2225-40. Epub 2011 Feb 24.
Chappard D, Baslé MF, Legrand E, Audran M.
Angers, France.

Bone quality is a complex set of intricated and interdependent factors that influence bone strength. A number of methods have emerged to measure bone quality, taking into account the organic or the mineral phase of the bone matrix, in the laboratory. Bone quality is a complex set of different factors that are interdependent. The bone matrix organization can be described at five different levels of anatomical organization: nature (organic and mineral), texture (woven or lamellar), structure (osteons in the cortices and arch-like packets in trabecular bone), microarchitecture, and macroarchitecture. Any change in one of these levels can alter bone quality. An altered bone remodeling can affect bone quality by influencing one or more of these factors. We have reviewed here the main methods that can be used in the laboratory to explore bone quality on bone samples. Bone remodeling can be evaluated by histomorphometry; microarchitecture is explored in 2D on histological sections and in 3D by microCT or synchrotron. Microradiography and scanning electron microscopy in the backscattered electron mode can measure the mineral distribution; Raman and Fourier-transformed infra-red spectroscopy and imaging can simultaneously explore the organic and mineral phase of the matrix on multispectral images; scanning acoustic microscopy and nanoindentation provide biomechanical information on individual trabeculae. Finally, some histological methods (polarization, surface staining, fluorescence, osteocyte staining) may also be of interest in the understanding of quality as a component of bone fragility. A growing number of laboratory techniques are now available. Some of them have been described many years ago and can find a new youth; others having benefited from improvements in physical and computer techniques are now available.

  • A Biomechanical Comparison of A Novel Thoracic Screw Fixation Method: Transarticular Screw Fixation versus Traditional Pedicle Screw Fixation.
Neurosurgery. 2011 Mar 24. [Epub ahead of print]
Yu Y, Xie N, Song S, Zhang W, Guo Q, Ni B, Luo J.

Transarticular screw fixation is used in the upper cervical and lumbar spine to achieve posterior spinal stability, and its biomechanical performance is proven to be similar to that of pedicle screw fixation. However, few studies have reported the use of transarticular screw fixation in the upper thoracic spine.
To biomechanically compare transarticular screws with pedicle screws in short-term cyclic loading in the upper thoracic spine.
Eight fresh human cadaveric spine specimens (T1-T3) were harvested and tested for six cycles in flexion, extension, lateral bending and torsion in their intact condition. Each specimen was then destabilized and restabilized with three fixation methods: the pedicle screw/rod construct, the transarticular screw/rod construct, and transarticular screws alone. The instrumented specimens were retested using the same protocol.
All fixation systems reduced the range of motion significantly with respect to flexion, extension, lateral bending and axial rotation (P<0.01). However, no significant difference was observed between the three instrumented groups.
This biomechanical study demonstrates in vitro that transarticular screws and pedicle screws have statistically similar biomechanical stability in a non-corpectomy model. Posterior transarticular screws may afford an alternative for internal fixation in the upper thoracic spine.

  • Combined posteroanterior fusion versus transforaminal lumbar interbody fusion (TLIF) in thoracolumbar burst fractures.
Injury. 2012 Jan 6. [Epub ahead of print]
Schmid R, Lindtner RA, Lill M, Blauth M, Krappinger D.
Innsbruck, Austria.

The optimal treatment strategy for burst fractures of the thoracolumbar junction is discussed controversially in the literature. Whilst 360° fusion has shown to result in better radiological outcome, recent studies have failed to show its superiority concerning clinical outcome. The morbidity associated with the additional anterior approach may account for these findings. The aim of this prospective observational study was therefore to compare two different techniques for 360° fusion in thoracolumbar burst fractures using either thoracoscopy or a transforaminal approach (transforaminal lumbar interbody fusion (TLIF)) to support the anterior column.
Posterior reduction and short-segmental fixation using angular stable pedicle screw systems were performed in all patients as a first step. Monocortical strut grafts were used for the anterior support in the TLIF group, whilst tricortical grafts or titanium vertebral body replacing implants of adjustable height were used in the combined posteroanterior group. At final follow-up, the radiological outcome was assessed by performing X-rays in a standing position. The clinical outcome was measured using five validated outcome scores. The morbidity associated with the approaches and the donor site was assessed as well.
There were 21 patients in the TLIF group and 14 patients in the posteroanterior group included. The postoperative loss of correction was higher in the TLIF group (4.9°±8.3° versus 3.4°±6.4°, p>0.05). There were no significant differences regarding the outcome scores between the two groups. There were no differences in terms of return to employment, leisure activities and back function either. More patients suffered from donor-site morbidity in the TLIF group, whilst the morbidity associated with the surgical approach was higher in the posteroanterior group.
The smaller donor-site morbidity in the posteroanterior group is counterbalanced by an additional morbidity associated with the anterior approach resulting in similar clinical outcome. Mastering both techniques will allow the spine surgeon to be more flexible in specific situations, for example, in patients with neurological deficits or severe concomitant thoracic trauma.

  • Cost-effectiveness of Denosumab for the treatment of postmenopausal osteoporosis.
Osteoporos Int. 2011 Mar;22(3):967-82.
Jönsson B, Ström O, Eisman JA, Papaioannou A, Siris ES, Tosteson A, Kanis JA.

Jonsson et al. from Stockholm reports that Denosumab is a cost-effective alternative to oral osteoporosis treatments, particularly for patients at high risk of fracture and low expected adherence to oral treatments.
Link: http://www.ncbi.nlm.nih.gov/pubmed/20936401

  • Direct Lateral Approach to Pathology at the Craniocervical Junction: A Technical Note.
Neurosurgery. 2011 Nov 8
Abdullah KG, Schlenk RS, Krishnaney A, Steinmetz MP, Benzel EC, Mroz TE.

Abdullah et al. from Cleveland report a direct lateral approach to the craniocervical junction.
Approaches to the foramen magnum and upper cervical spine traditionally include posterior midline, far lateral, and endoscopic endonasal approaches. The far lateral approach is a well-established technique for the removal of pathology ventrolateral to the brainstem and the craniocervical junction, but may be too extensive for lesions limited to areas far from the midline.
We employed an approach directly overlying ventral or lateral pathology.
Two cases are presented in which the direct lateral approach followed by an occipitocervical fusion were successfully performed.
This approach can be considered for patients in whom a ventral decompression is necessary but an endoscopic endonasal approach is undesirable, or when a ventral, lateral, and ventrolateral resection of tumor, pannus, or infection is required.
Link: http://www.ncbi.nlm.nih.gov/pubmed/22072127

  • Development and validation of a disease model for postmenopausal osteoporosis.
Osteoporos Int. 2011 Mar;22(3):771-80. Epub 2010 Aug 11.
Gauthier A, Kanis JA, Martin M, Compston J, Borgström F, Cooper C, McCloskey E; Committee of Scientific Advisors,
International Osteoporosis Foundation.

This article describes the development of a model for postmenopausal osteoporosis (PMO) based on Swedish data that is easily adaptable to other countries.
The aims of the study were to develop and validate a model to describe the current/future burden of PMO in different national settings.
For validation purposes, the model was developed using Swedish data and provides estimates from 1990. For each year of the study, the "incident cohort" (women experiencing a first osteoporotic fracture) was identified and run through a Markov model using 1-year cycles until 2020. Health states were based on the number of fractures and death. Fracture by site (hip, vertebral, and non-hip non-vertebral) was tracked for each health state. Transition probabilities reflected site-specific risk of death and subsequent fractures. Bone mineral density (BMD) was included as a model output; model inputs included population size and life tables from 1970 to 2020, incidence of fracture, relative risk of subsequent fractures based on prior fracture, relative risk of death following a fracture by site, and BMD by age (mean and standard deviation).
Model predictions averaged across age groups estimated the incidence of hip, vertebral, and other osteoporotic fractures within a 5% margin of error versus published data. In Sweden, the number of osteoporotic fractures is expected to rise by 11.5% between 2009 and 2020, with a shift towards more vertebral fractures and multiple fractures.
The current PMO disease model is easily adaptable to other countries, providing a consistent measure of present and future burden of PMO in different settings.
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/20700580
Full text: http://www.springerlink.com/content/kk50v7721p12637j/

  • A prospective, randomized trial comparing expansile cervical laminoplasty and cervical laminectomy and fusion for multilevel cervical myelopathy.
Neurosurgery. 2012 Feb;70(2):264-77.
Manzano GR, Casella G, Wang MY, Vanni S, Levi AD.
Department of Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida.

Controversy exists as to the best posterior operative procedure to treat multilevel compressive cervical spondylotic myelopathy.
To determine clinical, radiological, and patient satisfaction outcomes between expansile cervical laminoplasty (ECL) and cervical laminectomy and fusion (CLF).
We performed a prospective, randomized study of ECL vs CLF in patients suffering from cervical spondylotic myelopathy. End points included the Short Form-36, Neck Disability Index, Visual Analog Scale, modified Japanese Orthopedic Association score, Nurick score, and radiographic measures.
A survey of academic North American spine surgeons (n = 30) demonstrated that CLF is the most commonly used (70%) posterior procedure to treat multilevel spondylotic cervical myelopathy. A total of 16 patients were randomized: 7 to CLF and 9 to ECL. Both groups showed improvements in their Nurick grade and Japanese Orthopedic Association score postoperatively, but only the improvement in the Nurick grade for the ECL group was statistically significant (P < .05). The cervical range of motion between C2 and C7 was reduced by 75% in the CLF group and by only 20% in the ECL group in a comparison of preoperative and postoperative range of motion. The overall increase in canal area was significantly (P < .001) greater in the CLF group, but there was a suggestion that the adjacent level was more narrowed in the CLF group in as little as 1 year postoperatively.
In many respects, ECL compares favorably to CLF. Although the patient numbers were small, there were significant improvements in pain measures in the ECL group while still maintaining range of motion. Restoration of spinal canal area was superior in the CLF group.

  • Chronic cervical spinal cord injury: DTMRI correlates with clinical and electrophysiological measures     (Date added: February 21th, 2012)
  • A systematic review on the effects of pharmacological agents on walking function in people with sci     (Date added: February 21th, 2012)
  • Neurosurgery tops malpractice risk     (Date added: February 21th, 2012)
  • Patient Satisfaction After Anterior Cervical Discectomy and Fusion     (Date added: February 21th, 2012)
  • Segmental Contribution Toward Total Cervical Range of Motion:Cervical Disc Arthroplasty vs Fusion     (Date added: February 21th, 2012)
  • Anatomical distribution of vertebral fractures: comparison of pediatric and adult spines     (Date added: February 21th, 2012)
  • Compound action potentials during spinal cord neurostimulation     (Date added: January 20th, 2012)
  • Partial Ipsilateral C7 Transfer to the Upper Trunk for C5-C6 Avulsion of the Brachial Plexus     (Date added: January 17th, 2012)
  • Adolescent pregnancy is associated with osteoporosis in postmenopausal women      (Date added: January 16th, 2012)
  • Comparison of C1-C2 fixation tecchniques: Magerl technique vs Goel-Harms technique      (Date added: November 27th, 2011)
  • Costotransversectomy for Harlequin Syndrome       (Date added: November 14th, 2011)
  • Yoga for chronic low back pain: a randomized trial       (Date added: November 7th, 2011)

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